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The big differences in the House and Senate versions of the state budget have lawmakers locked in talks as the clock ticks.

One change added to the budget by Senate Republicans could put delays on a program designed to help the state's most troubled and vulnerable kids.

And some of their families are saying that could be devastating and even cost lives.

All this week in the state of Ohio.

Welcome to the state of Ohio, I'm Karen Kasler the state budget deadline is just days away, but the fiscal year expiring on June 30th and as usual, things are coming down to the wire and changing all the time.

Statehouse news bureau correspondent Andy Chow has the latest as we record this show on Friday.

The Ohio House passed its budget plan in April and the Senate made its own changes to the bill two weeks ago.

Some of them are dramatic, such as a rewrite of the House's school funding plan, along with some controversial additions, for instance, on state supported child care.

Now, leaders from both chambers must iron out a final plan to send to Gov.

Mike DeWine before the end of the month.

The process goes through conference committee, which met only to briefly convene for a quick update.

The House and Senate continued positive negotiations and are making progress on the operating budget.

The purpose of today's meeting is to convene the committee and to recess until the call of the chair, which will not be today.

So with no further business to come before us, we stand in recess.

From there, all the action of negotiations happen behind closed doors and there certainly a lot to sift through in those talks, such as proposed tax cuts the House wants and across the board, two percent income tax cut.

The Senate raise that to five percent with leaders looking into broadening that tax cut using the three billion dollar surplus.

Lawmakers say the difference between the school funding plans and the two versions of the budget has been a main point of debate.

The House, after years of research on the subject, proposed a plan that simply put calculated state aid to schools with a formula of 60 percent property taxes, 40 percent income that would cost the state about two billion dollars phased in over the next six years.

The Senate scrapped that plan with one that sticks with a two year formula similar to the existing one, with some tweaks and increases budgets for more school districts.

Republican Senate President Matt Huffman says their plan is more reliable, but critics say it's shortsighted.

Governor Mike DeWine.

The budget plan had 250 million dollars to expand broadband services.

The House cut that to 190 million and the Senate cut that to zero.

In addition to banning public private partnerships to provide broadband services in areas where private companies already distribute Internet, DeWine says broadband was one of the issues they were debating in budget negotiations language.

We've made it very, very clear that some of the proposed changes simply would be devastating to expanding broadband in the state.

D'Wayne says he feels optimistic there will be adequate money for broadband in the final plan.

Another pressing concern noted by DeWine was the Senate's change to the accountability program for child care facilities that serve children using federal assistance.

Child must enroll in the step up to quality program to be part of that federal aid system.

But the Senate wants to eliminate step up to quality, saying it cost the state too much and it creates a heavy amount of administrative work for senators.

But DeWine says the program assures quality early childhood education.

Democratic lawmakers are also voicing their concerns with the changes, including allowing remote workers to claim a refund on municipal taxes in 2020, resulting in less revenue for local governments.

The Dems are also fighting means testing added to the Supplemental Nutrition Assistance Program, or SNAP, that would place limits on how much a recipient's car can be worth and a so-called medical conscience clause that would allow medical professionals to deny treatment to patients if doing so would violate their personal beliefs.

They also voiced frustration about a House added provision to prevent doctors who work with abortion clinics that receive variances from the state, from practicing medicine and hospitals that get state dollars.

The budget, which covers Ohio spending for fiscal years 2022 and 2023, must be signed by June 30th, Andy Chow Statehouse News Bureau.

Thursday was a busy and intense day on the House and Senate floors, with the budget negotiations continuing in the background.

The House passed a bill allowing college athletes to be compensated for their name, image and likeness.

They'll receive unanimous support in the Senate and pass the House committee with only one no vote.

But at the last minute, Republicans in the House attached the hotly contested ban on transgender athletes and women's sports to the bill.

Democrats erupted in anger and Speaker Bob Kopp did not gavel them down.

The same Women's Sports Act is the fairness issue for women to be able to achieve their dreams and athletics in our state.

And it's crucial to preserving women's rights and the integrity of women's and girls sports across our country.

Treating female athletes are currently losing scholarships, opportunities, metals, education and training opportunities.

This.

Minority Leader Amelia SAIC's called it, quote, this awful, terrible, disgusting, vile, worse than the sticky stuff on the bottom of my shoe amendment and noted that it comes during pride month, Gov.

Mike DeWine said in a statement of the amendment that his fellow Republicans passed in the House, quote, This issue is best addressed outside of government, through individual sports leagues and athletic associations, including the Ohio High School Athletic Association, who can tailor policies to meet the needs of their member athletes and member institutions.

A Senate Republican caucus spokesperson said that chamber would not take up that amendment as part of the bill because it hasn't had any hearings in the Senate.

But senators attach the college athlete compensation legislation to a House bill that expands the ability to get a veteran's ID card.

And they also added into that bill their version of a bill to regulate sports betting in Ohio.

The House and Senate have clashed over the regulation of sports gambling for years.

Cop said he doesn't think the chambers will agree on sports gambling before the July 4th break.

And Senate President Matt Hoffman said the issue of college athlete compensation could be added to the budget, along with the bingo portion of the sports betting package.

Among the items added to the budget by Senate Republicans was a proposal that would require Medicaid to essentially redo its procurement process for the managed care plans that want to work with the state.

The amendment would require the process to examine whether applicants are Ohio based, the number of jobs created or lost with the states awarding of a contract.

Other economic factors and whether the managed care organization has a record of quality services and customer satisfaction advocates have said that will cause major problems and delays, especially in the new Ohio Rise program.

The one billion dollar Ohio Rise program is aimed at coordinating care for kids with complex and expensive mental and behavioral health issues while keeping families intact during treatment.

Lauren Impasse with the Center for Community Solutions has deep experience with Ohio Medicaid.

So the Ohio race program is an answer to a decades long problem that we have in Ohio in regards to coordinating care and providing services for children with medically complex needs.

In particular, this is a response to some of the work that's been ongoing in the last few years around what we call multisystem youth, essentially children and adolescents who may be engaged in multiple systems, whether that's the developmental disability system or the correction system, the behavioral health system, so on and so forth.

Oftentimes parents and families have to relinquish custody to the state, literally hand their children over to the state in order to receive some basic services.

So high rise was created as a continuation of the work to better coordinate services and care for children and families who have these complex needs and to end custody relinquishment in the state of Ohio.

The the state budget then, you know, inserted these amendments, essentially, which would derail that effort and all efforts really related to recent reforms in the Medicaid program, including reforms around pharmacy benefit management, because it would essentially mandate that the Ohio Department of Medicaid rebid its contracts with managed care.

The challenges that all of these different reforms are interlinked.

So it'd be like taking a gear out of a clock and expecting it to read the right time.

It just does not work.

So when the Senate budget passed, there was an amendment that would take Ohio rise out of this.

But you're saying that because there is this interconnection, just doing that won't work, like you just said.

Yeah, it's it's not going to work.

And the reason why is a lot of the functions that we are talking about here in terms of the Medicaid program used to be within one procurement or one contract with these mega contractors.

Right.

And Medicaid, like a third of all the money that we budget in the state of Ohio flows through these contractors.

And we used to have pharmacy benefit management, for example, happened within the single contract.

And what the General Assembly said is, well, we don't like spread pricing.

Right.

We don't like the pharmacy middleman.

And it's costing us a lot of money.

We're not getting the the right bang for our buck.

So we would like you to change that system.

And thus we have now a single pharmacy benefit management program that is also managed care, the administrative simplification for providers to be able to credential at one place to bill at one place that is also a managed care product.

And all of these managed care efforts are really threaded together.

They are interwoven.

And so the operational, financial and policy and legal construction of these contracts are intermingled.

So if you don't have one part of it.

Right, if you don't have the.

General procurement that says thou shalt do the following in regards to Ohio rise or in regards to pharmacy benefit management, you have to renegotiate all those other contracts.

And there's been years worth of development in this with that extensive public input over a large amount of time.

The General Assembly has mandated some of these reforms to take place.

So it really just sort of throws a grenade into all those reform efforts.

And there are real families and real kids in this program who need help, up to sixty thousand of them.

Mark Butler of Columbus is the father of twenty three year old Andrew, who was diagnosed with autism as a toddler, but also has a severe intellectual disability, several mental illnesses.

And he's nonverbal.

And as he became a teen, he also became violent.

Andrew was admitted to Cincinnati Children's Hospital a few years ago.

And when it was time to discharge him, the butlers were told it was too dangerous for Andrew and for the rest of the family for him to go home.

Mark Butler thought Medicaid and private insurance would cover the costs of residential treatment, but they didn't.

So he and his wife surrendered custody of their youngest son to get him the residential treatment that he needed.

He was sent to a facility in near Ironton, Ohio, which from Columbus is a pretty big journey through a lot of hilly roads.

But my wife and I made a commitment that we would go and see them every weekend.

And the reason for that is when you have a kid who's nonverbal, he doesn't understand Skype resume, you can't read or write.

The only way to have a relationship with him is to just be close to him.

And that was taken away from us when he was sent someplace so far away.

Now we're lucky he was a boy.

A lot of girls are out of state to receive their treatments.

That first weekend we drove there and they told us, you know what?

We don't think he's ready to see you, so you're not allowed to see him.

And so my wife and I just spent the day in the car looking at the building, just holding each other and crying.

Just we just wanted to be close, you know, we that's what we wanted.

And after that, we visited every single weekend, twenty five thousand miles longer than the circumference of the Earth, until eventually we were able to have custody returned to us.

We were able to get him back up into our community.

And the thing is, the treatment worked.

That experience was effective.

We went from having 10 to 20 very violent outbursts at home to my goodness, in the past seven years we've had three.

So it it worked.

But when I made that call to Children's Services, it was the hardest call I ever had to make in my whole life.

Because we didn't want to surrender custody, we just wanted to get help, if he had leukemia, he he wouldn't we would have had to go through that, certainly.

And I want to hang up the phone.

I remember saying I wouldn't wish this on my worst enemy, this feeling.

And I promised that I would do everything I could to make sure other parents didn't have to do that.

The Butler situation is more stable now, and our lives a few minutes away from his family and sees his parents every weekend.

But things are desperate for Lisa, north of Columbus.

She says her 12 year old daughter Hannah, one of her five kids, three of whom are foster children, is bubbly, artistic, athletic and funny, experienced significant trauma in her first years of life before she and her brother were adopted by the Norris family.

Lisa says Hannah has been in what she calls a constant cycle of aggression over the last year during the pandemic and ran into the same problem that Mark Butler had.

Medicaid and private insurance wouldn't cover the fifteen thousand dollars a month that they would have to pay up front for Hannah's residential treatment.

Lisa found some local funding and money that was in the last operating budget for multisystem youth, but it only lasted six months.

She was making progress, but we ran out of funding and she had to be sent home cold turkey.

That transition was horrendous and our behavior is escalated worse because again, with a child with reactive attachment disorder, every change you make makes it worse, because that's just proving to them that nothing is stable and no one's coming for them and nothing's being taken care of.

But we came into this.

We begged county systems.

I'm fighting two agencies whose sole purpose is to help protect families and children.

And they don't have the resources either.

And the only so it came down to two, three weeks ago on the 11th of this month, we were forced to go to court and beg a judge to temporarily give custody to the county because they do have the funding to fund her residential placement.

But there's no mechanism in place for them to pay that same tab and allow her to remain in my custody.

What has resulted since then in that desperate attempt to keep not only her and my other three children in my home physically safe?

Because if anything happens to the other three kids in my home, then I'm charged.

Also, when I went to the county with ask, begging for help, please, like, I need more hands in my home.

I need more help.

I can't.

I can't.

I'm trained in restraints.

Ten years over, I can't safely restrain one hundred thirty five pound kid by myself.

They don't do it that way.

Even at the hospital.

It's a multi-person restraint.

They have injectable sedatives, they have safe rooms.

I can't legally even contain her in a room.

If I borrow a door, lock a door, I'm being charged.

So there's no way to keep her safe in the home.

As a treatment parent foster parent, I've had caseworkers in my house for years.

They've even said you've done everything you absolutely can.

Your house is like psych ward level safety.

There's nothing more you can do in your home short of adding more hands, adding more therapist, and we don't have the funding for that.

So when we turned over custody in an attempt to get that residential placement, we have the recommendations.

We have multiple professionals in writing saying this is what she needs to stand.

Her best chance of being healthy and safe turned her over to the county.

The county is designed as a system for triaging abused and neglected children.

So my daughter went into that system.

She's not an abused or neglected child.

She's a mentally ill child.

So their modus operandi is this.

Put her in the least restrictive placement, which for them the first night was a homeless shelter.

So she spent her first night at the homeless shelter locally and was transported to Children's within twenty four hours after another suicide attempt.

She has then been bounced to three other placements since then.

She is still not in a residential facility today.

She still has no new therapy or treatment put in place today, three weeks later.

And all we're doing is adding more years and more trauma to my daughter and my family that we will eventually, hopefully get this one thing fixed and get her back home.

We'll have to triage.

Lisa Norris says the funding for multisystem use, like her daughter Hannah and Marks on Andrew needs to be addressed.

And she says the Ohio Rise program will help, but if it's delayed, do a requirement of a new Medicaid procurement process.

She says it will be devastating for her family.

We can't afford to wait for Hannah especially.

It literally means the difference between her life and death.

Six months down the road, my child might not be alive in this system.

We can't keep her safe without the funding.

And not only is that absolutely soul crushing to stand by and feel so helpless while we have the treatment, it's right there behind the glass door.

We have the treatment to be able to help her.

We don't have the money.

It makes a huge difference for our family and my little girl.

But we're also looking at a twelve year old little girl who is six years away from.

Adulthood and as a parent and a community member and an educator, I also look at this and go, my God, if she turns 18 and we've done nothing else but bouncer through the system, what are we sending out into the community?

We're going to have a very troubled adult and then it becomes everybody's family that should be concerned.

I'm doing everything I humanly can to head that off for her benefit, for our family's benefit, for everyone's benefit.

We just need some help.

The redo of the Medicaid procurement process was added into the budget by Senate President Matt Huffman of Lima and Senator Teresa Gavron of Bowling Green, both from northwest Ohio.

And it comes after a northwest Ohio provider that was not chosen by Ohio Medicaid in the competitive bidding process raised questions.

Paramount health care, owned by paramedics, said in a statement that not being included will, quote, needlessly disrupt care coordination and support for nearly a quarter of a million Ohio adults and children who are enrolled in Medicaid.

Further, the decision will result in over 600 lost jobs in Ohio and economic losses estimated at eighty one million dollars annually for the state.

This is an anti-competitive proposal.

The particular individual insurance company that has been promoting this has been citing things like jobs and economic impact.

The reality is, first of all, we want a cost efficient, effective Medicaid program and we don't do very well.

Right.

We're ranked 47 out of 50 states in regards to value.

We consistently underperform in terms of children's health care, in terms of the management of chronic disease.

And as someone who regularly engages policymakers, the biggest question is how do we save money in Medicaid?

While competition is part of that equation, most of Medicaid is actually managed by these private contractors and is a matter of contract and performance behind that contract.

So we're essentially guaranteeing that underperformers are insured to do business with the state of Ohio without achieving anything for that money.

The other thing to to pay attention to here is in regards to those plans that were awarded, there are new companies coming into Ohio.

And that means a couple of things.

Number one, it increases competition.

This is why the Buckeye Institute, for example, is taking the same position we are.

It increases competition, which can help lower prices, but also it's likely going to create more jobs.

But, you know, I find it sort of interesting because this is the first time I've ever heard, you know, a desire for Medicaid to directly create jobs rather than require Medicaid beneficiaries to engage in work requirements.

And the new contract, for example, does a lot more in terms of employment training and that sort of thing.

So why don't we just expect more out of these contractors rather than guarantee, you know, the business of of Ohio taxpayer money be guaranteed to to one or two vendors.

Ohio Medicaid informed Paramount last week that its appeal to reconsider its application was rejected.

In its letter, Ohio Medicaid wrote The Paramount only made reference to Ohio rise 17 times and its application while the top applicant, Humana, referenced Ohio rise ninety four times.

The second place applicant Aetna referenced Ohio rise ninety one times, the letter says.

In part, Paramount does not appear to fully grasp or otherwise has decided not to embrace the vision for the future of the program.

Paramount President Lori Johnston told the Toledo Blade a few days later when asked about Ohio arise.

It is a very unique population and we support the program and having them have their own program, but it is no longer part of what we would be responsible for.

It is their own program and not what our procurement was about.

I guess in hindsight, we should have thrown that buzzword out a few times.

I don't think the number of times we used Ohio RI should be indicative of our approach and understanding of that plan.

We support the program and are very committed to seeing the program is successful with that population that incensed advocates, and especially some Ohio Rice families who responded on social media by sharing photos of their kids with the hash tag.

Not a buzzword.

When I hear I have heard folks say, especially the folks who are trying to fight this procurement, say, oh yeah, we support Ohio rise.

It's a special population that needs the help.

And maybe we didn't get the contract because we just didn't use the buzzword.

That is super offensive to me who has been working on this for a long time.

It's offensive to parents who are experienced trauma right now because of high rises and a buzzword.

It represents the change we've been fighting for.

And if you're not part of the solution, you're part of the problem.

The money in the last budget, how parents of four hundred and sixty nine children to avoid having to turn over custody to get them the treatment they need.

But again, there are as many sixty thousand kids who could be a part of the Ohio Rise program.

And that's it for this week for my colleagues at the Statehouse News Bureau of Ohio Public Radio and Television.

Thanks for watching.

Please check out our website at statenews.org and you can follow us and the show on Facebook and Twitter.

And please join us again next time for the state of Ohio.

Support for the statewide broadcast of the state of Ohio comes from medical mutual, providing more than one point four million Ohioans peace of mind with a selection of health insurance plans online at Medd Mutual dotcom slash Ohio by the law offices of PorterWright Morris and Arthur LLP.

Now with eight locations across the country, PorterWright is a legal partner with a new perspective to the business community.

More at PorterWright Dotcom and from the Ohio Education Association, representing 100 24000 members who work to inspire their students to think creatively and experience the joy of learning online at O H E A dot org.